Can Diabetes Cause Erectile Dysfunction?
Sex, contraception and HRT
Although modern society has removed many of the taboos and inhibitions surrounding sex and contraception, many people still find it a difficult subject on which to ask personal questions.
There are very many old wives’ tales about diabetes and sex, and most of these are rubbish. Basically, people with diabetes are no different from people without diabetes in any aspect of sex, sexuality, fertility, infertility and contraception. There are, however, a few exceptions, such as the undoubted risk of impotence in men who have had diabetes for many years. In such people, there is usually evidence of neuropathy (nerve damage), although in some cases this is only mild. Even this has to be considered in relationship to the fact that impotence is a common problem in people without diabetes. There is certainly good evidence that women with diabetes are totally without risk of developing any problem analogous to impotence. Frigidity, on the other hand, is not uncommon in women, just as impotence is not uncommon in men, with and without diabetes.
Various contraceptive devices have at times been claimed to be less effective in women with diabetes – the evidence to support this is poor and, in our opinion, people with diabetes should consider themselves entirely normal as far as contraceptive practice is concerned. There was, in the 1960s and 70s, much emphasis on the potential risk of precipitating diabetes when oral contraceptives were taken. It is now felt that the risks were grossly exaggerated in the media.
Impotence
I am male and have been diagnosed with diabetes. I have been told that diabetes could affect my sex life. Is this correct?
No. The vast majority of people, both male and female, are able to lead completely full and normal sex lives. This does not mean that problems do not occur but that most of these problems have nothing to do with diabetes. If, for any reason, diabetes control is lost with severe hyperglycaemia (high blood glucose), then this could affect your sex life. In a minority of people who have either severe nerve damage or arterial disease, a loss of sexual potency can be directly attributed to diabetes but this is uncommon. The majority of people, both male and female, can look forward to a completely normal sex life.
Is it normal for people with diabetes to suddenly find themselves totally uninterested in sexual intercourse?
My husband is really upset about my lack of desire! No more so than in people without diabetes. The feeling that you describe is more common in females than males, but no more common in those with diabetes than those without have had erratic blood glucose levels recently.
Would low blood glucose affect my ability to achieve or maintain an erection and more importantly, my ability to ejaculate?
No, not unless the blood glucose is very low (less than 2 mmol/litre), in which case many aspects of nerve function are impaired; this could affect both your potency and ability to ejaculate. These will return to normal when your blood glucose is stable.
Am I likely to become impotent? I have had diabetes for 5 years.
There is no doubt that many people with diabetes worry about possible complications that may lie ahead of them at some stage in the future, and many men have loss of potency at the top of their worry list. Our advice is to worry more about keeping your diabetes under control and balanced and less about what future skeletons there might be in the cupboard. By ensuring that you have good control of your diabetes, you are doing everything that you possibly can to avoid trouble in the future, and the chances are that you will steer clear of difficulties throughout your life.
My husband, who is middle-aged with Type 1 diabetes, has been impotent for the past 2 years. Please will you explain his condition as I am worried that my teenage son, who also has diabetes, may also discover that he is impotent.
Impotence (or the fear of it) worries many people and is certainly not so rare that we can ignore it. It has been claimed that as many as 20% of males with diabetes (though the figure is probably not as high as this) may at some stage become impotent. Most impotent men are not suffering from diabetes: anxiety, depression, overwork, tiredness, stress, guilt, alcohol excess and grief can contribute to impotence. Any man may find that he is temporarily impotent and there is no reason why men with diabetes should not also experience this. Fear of failure can perpetuate the condition. Overwork or worry is frequently the cause of lack ofinterest in sex and even of impotence. Excess alcohol can cause prolonged lack of potency.
Some men with diabetes do become impotent, owing to problems with the blood supply or the nerve supply to the penis. This usually develops slowly and in the younger person we believe it can be prevented by strict blood glucose control. In the older person the condition does not usually respond well to treatment. In this age group impotence is more commonly due to other factors and not to diabetes. We hope that you will be encouraged to discuss the matter further with your own doctor or with the doctor at the diabetes clinic.
My wife left me because I was impotent and the doctors say that there is nothing they can do for me – why was I not told about any treatments available?
We are surprised that the doctors said that there is nothing they can do for you, because, even for those who are completely impotent, there are now several treatments that can be tried.It must be very upsetting to think that your marriage broke up on account of your impotence. In our experience, most wives are sympathetic and understanding about impotence (whatever the cause) provided that both partners can talk about the matter in an open manner. We have known frank discussions leading to an increase of affection within marriage. Keeping things bottled up leads to the aggression and resentment that emerges from your question.
Recently, I have had trouble keeping an erection – has this anything to do with my diabetes? I also had a vasectomy a few years ago.
This is difficult to answer without knowing more about you and your medical history. Certainly it is unlikely that the vasectomy had anything to do with your current problem. Failure to maintain an adequate erection may occasionally be an early symptom of diabetic neuropathy. However and at least as commonly, it isoften a symptom of overwork or simply growing older and you would need detailed tests to be sure of the cause.
I suffered a stroke affecting the right side of my body 12 months ago at the age of 40 and now suffer from partial impotence. The onset seemed to coincide not with the stroke but with taking anticoagulants. Are these known to cause impotence? I have heard that blood pressure tablets can cause impotence and I have been taking these for 3 months and wonder whether this is a factor?
A severe stroke can sometimes be associated with impotence. A stroke is often due to narrowing of the arteries inside the head: the arteries elsewhere may also be narrowed and, if those supplying blood to the penis are affected, it could contribute to your impotence. You are also quite right about the question of drugs. Some blood pressure lowering drugs may cause impotence and can interfere with ejaculation. It would be unwise to stop taking the drugs since this would lead to loss of control of your blood pressure without first asking your doctor to try you on different tablets for your high blood pressure to see if this helps. Anticoagulant tablets are not known to cause impotence.
I have been impotent for months. Is there some drug or hormone that will help me?
It is extremely rare that impotence is due to a hormonal abnormality. Many cases of impotence are due to psychological causes and often respond to appropriate advice and occasionally drug treatment. If you have a hormonal defect, treatment with replacement hormones (testosterone) will cure that particular form of impotence. It is essential to get a correct diagnosis in order to ensure appropriate therapy. It has been shown that the injection of a drug called papaverine directly into the penis can sometimes be helpful. It leads to an erection and, in people who have become impotent; the result is often good enough to make this an acceptable and effective form of therapy.
Viagra (sildenafil) is the first oral treatment for impotence tobe licensed in the UK. It works by helping to relax the blood vessels in the penis, allowing blood to flow into the penis causing an erection. It will only help a man to get an erection if he is sexually stimulated. It is available to men with diabetes on the NHS, but officially the amount is limited to 4 tablets a month. It is important to use the full strength (100 mg) as lower amounts are less likely to have the desired effect.
I have used Viagra for 3 years for impotence. At first it worked very well but the effect now seems to be wearing off. Is there anything else I can try?
Recently another drug has come onto the market, which is designed to help people improve their erections. It is called apomorphine (or Uprima), and should be placed under the tongue about 20 minutes before you want sex. Apomorphine has about the same success rate as Viagra, but may help some people who do not respond to Viagra. The starting dose of apomorphine is 2 mg but, if this is no help, you can try a 3 mg dose. Apomorphine seems to be a safe drug, but you should avoid it if you have severe heart problems or if your blood pressure is low. You should wait 8 hours before repeating the dose of apomorphine.
Is there any other treatment for impotence apart from Viagra?
Yes. Depending on the cause, there are several effective forms of therapy. Counselling by a therapist trained in this subject can be helpful, particularly in cases where the stresses and conflicts of life are the root cause. Testosterone is effective in those with a hormone deficiency. Vacuum therapy, with a device that looks like a rigid condom, is also a (if expensive) form of therapy, which has been useful in many cases. Injections of papaverine or alprostadil into the penis, and penile implants (which require an operation) are also effective. The best choice for an individual requires a considerable amount of thought and discussion with your doctor. Many diabetes clinics hold special clinics for treatment of impotence.
After sexual intercourse I recently suffered quite a bad hypo. Is this likely to happen again and if so, what can be done to prevent it?
This form of physical activity can, like any other, lower the blood glucose level and lead to hypoglycaemia. When this happens, and it is not at all uncommon, then the usual remedies need to be taken – more food or sugar beforehand or immediately after-wards. You may find it useful to keep some quick-acting carbohydrate close at hand, perhaps on a bedside table.
